Multiple Errands Test (MET)

Evidence Reviewed as of before: 08-05-2013
Author(s): Valérie Poulin, OT, PhD candidate; Annabel McDermott, OT
Editor(s): Nicol Korner-Bitensky, PhD OT
Expert Reviewer: Deirdre Dawson, PhD OT

Purpose

The Multiple Errands Test (MET) evaluates the effect of executive function deficits on everyday functioning through a number of real-world tasks (e.g. purchasing specific items, collecting and writing down specific information, arriving at a stated location). Tasks are performed in a hospital or community setting within the constraints of specified rules. The participant is observed performing the test and the number and type of errors (e.g. rule breaks, omissions) are recorded.

In-Depth Review

Purpose of the measure

The Multiple Errands Test (MET) evaluates the effect of executive function deficits on everyday functioning through a number of real-world tasks (e.g. purchasing specific items, collecting and writing down specific information, arriving at a stated location). Tasks are performed in a hospital or community setting within the constraints of specified rules. The participant is observed performing the test and the number and type of errors (e.g. rule breaks, omissions) are recorded.

The Multiple Errands Test was developed by Shallice and Burgess in 1991. The measure was intended to evaluate a patient’s ability to organize performance of a number of simple unstructured tasks while following several simple rules.

See Alternative Forms sections below for information regarding other versions.

Features of the measure

Items:

The original Multiple Errands Test (Shallice and Burgess, 1991) was comprised of 8 items: 6 simple tasks (e.g. buy a brown loaf of bread, buy a packet of throat pastilles), 1 task that is time-dependent, and 1 that comprises 4 subtasks (see Description of tasks, below). It should be noted that the MET was originally devised in an experimental context, rather than as a formal assessment.

Description of tasks:

The original Multiple Errands Test (Shallice and Burgess, 1991) was comprised of 8 written tasks to be completed in a pedestrian shopping precinct. Tasks and rules are written on a card provided to the participant before arriving at the shopping precinct. Of the 8 tasks, 6 are simple (e.g. buy a brown loaf of bread, buy a packet of throat pastilles), the 7th requires the participant to be at a particular place 15 minutes after starting the test, and the 8th is more demanding as it comprises 4 sets of information that the participant must obtain and write on a postcard:

  1. the name of the shop most likely to have the most expensive item;
  2. the price of a pound of tomatoes;
  3. the name of the coldest place in Britain yesterday; and
  4. the rate of the exchange of the French franc yesterday.

The card also includes instructions and rules, which are repeated to the participant on arrival at the shopping precinct:

“You are to spend as little money as possible (within reason) and take as little time as possible (without rushing excessively). No shop should be entered other than to buy something. Please tell one or other of us when you leave a shop what you have bought. You are not to use anything not bought on the street (other than a watch) to assist you. You may do the tasks in any order.“

Scoring:

The participant is observed performing the test and errors are recorded according to the following categorizations:

  • Inefficiencies: where a more effective strategy could have been applied
  • Rule breaks: where a specific rule (either social or explicitly mentioned in the task) is broken
  • Interpretation failure: where requirements of a particular task are misunderstood
  • Task failure: where a task is either not carried out or not completed satisfactorily.

Time taken to complete the assessment is recorded and the total number of errors is calculated.

Alternative versions of the Multiple Errands Test

Different versions of the MET were developed for use in specific hospitals (MET – Hospital Version and Baycrest MET), a small shopping plaza (MET – Simplified Version), and a virtual reality environment (Virtual MET). For each of these versions, 12 tasks must be performed (e.g. purchasing specific items and collecting specific information) while following several rules.

MET – Hospital Version (MET-HV – Knight, Alderman & Burgess, 2002)

The MET-HV was developed for use with a wider range of participants than the original version by adopting more concrete rules and simpler tasks. Clients are provided with an instruction sheet that explicitly directs them to record designated information. Clients must achieve four sets of simple tasks, with a total of 12 separate subtasks:

  1. The client must complete six specific errands (purchase 3 items, use the internal phone, collect an envelope from reception, and send a letter to an external address).
  2. The client must obtain and write down four items of designated information (e.g. the opening time of a shop on Saturday).
  3. The client must meet the assessor outside the hospital reception 20 minutes after the test had begun and state the time.
  4. The client must inform the assessor when he/she finishes the test.

The MET-HV uses 9 rules in order to reduce ambiguity and simplify task demands (Knight et al., 2002). Errors are categorized according to the same definitions as the original MET. The test is preceded by (a) an efficiency question rated using an end-point weighted 10-point Likert scale (“How efficient would you say you were with tasks like shopping, finding out information, and meeting people on time?“); and (b) a familiarity question rated using a 4-point scale (“How well would you say you know the hospital grounds?“). On completion the client answers a question rated using a 10-point scale (“How well do you think you did with the task?“).

MET – Simplified Version (MET-SV – Alderman, Burgess, Knight & Henman, 2003)

The MET-SV includes four sets of simple tasks analogous to those in the original MET, however the MET-SV incorporates 3 main modifications to the original version:

  1. More concrete rules to enhance task clarity and reduce likelihood of interpretation failures;
  2. Simplification of task demands; and
  3. Space provided on the instruction sheet for the participant to record the information they were required to collect.

The MET-SV has 9 rules that are more explicit than the original MET and are clearly presented on the instruction sheet.

Baycrest MET (BMET – Dawson, Anderson, Burgess, Cooper, Krpan & Stuss, 2009)

The BMET was developed with an identical structure to the MET-HV, except that some items, information and a meeting place are specific to the testing environment (Baycrest Center, Toronto). The BMET comprises 12 items and 8 rules. The test manual provides explicit instructions including collecting test materials, language to be used in describing the test, and a pretest section to ensure participants understand the tasks. Scoring was standardized to allow for increased usability. The score sheet allows identification of specific task errors or omissions, other inefficiencies, rule breaks and strategy use (please contact the authors for further details regarding the manual: ddawson@research.baycrest.org).

Virtual MET (VMET – Rand, Rukan, Weiss & Katz, 2009)

The VMET was developed within the Virtual Mall, a functional video-capture virtual shopping environment that consists of a large supermarket with 9 aisles. The system includes a single camera that films the user and displays his/her image within the virtual environment. The VMET is a complex shopping task that includes the same number of tasks (items to be bought and information to be obtained) as the MET-HV. However, the client is required to check the contents of the shopping cart at a particular time instead of meeting the tester at a certain time. Virtual reality enables the assessor to objectively measure the client’s behaviour in a safe, controlled and ecologically valid environment. It enables repeated learning trials and adaptability of the environment and task according to the client’s needs.

What to consider before beginning:

The MET is performed in a real-world shopping area that allows for minor unpredicted events to occur.

Time:

The BMET takes approximately 60 minutes to administer (Dawson et al., 2009).

Training requirements:

It is advised that the assessor reads the test manual and becomes familiar with the procedures for test administration and scoring.

Equipment:

  • Access to a shopping precinct or virtual shopping environment
  • Pen and paper
  • Instruction sheet (according to version being used)

Client suitability

Can be used with:

The MET has been tested on populations with acquired brain injury including stroke.

Should not be used with:

  • The MET cannot be administered to patients who are confined to bed.
  • Participants require sufficient language skills.
  • Some tasks may need to be adapted depending on the rehabilitation setting.

In what languages is the measure available?

The MET was developed in English.

Summary

What does the tool measure? The effect of executive function deficits on everyday functioning.
What types of clients can the tool be used for? The Multiple Errands Test can be used with, but is not limited to, clients with stroke.
Is this a screening or assessment tool? Assessment
Time to administer Baycrest MET: approximately 60 minutes (Dawson et al., 2009).
Versions
  • Multiple Errands Test (MET) (Shallice and Burgess, 1991)
  • MET – Simplified Version (MET-SV) (Alderman et al., 2003)
  • MET – Hospital Version (MET-HV) (Knight, Alderman & Burgess, 2002)
  • Virtual MET (Rand, Rukan, Weiss & Katz, 2009)
  • Baycrest MET (Dawson et al., 2009)
  • Modified version of the MET-SV and MET-HV (including 3 alternate versions) (Novakovic-Agopian et al., 2011, 2012)
Other Languages N/A
Measurement Properties
Reliability

Internal consistency:

One study reported adequate internal consistency of the MET-HV in a sample of patients with chronic acquired brain injury including stroke.

Test-retest:

No studies have reported on the test-retest reliability of the MET with a population of patients with stroke.

Intra-rater:

No studies have reported on the intra-rater reliability of the MET with a population of patients with stroke.

Inter-rater:

  • One study reported excellent inter-rater reliability of the MET-HV in a sample of patients with chronic acquired brain injury including stroke.
  • One study reported adequate to excellent inter-rater reliability of the BMET in a sample of patients with acquired brain injury including stroke.
Validity

Content:

No studies have examined content validity of the MET with a population of patients with stroke.

Criterion:

Concurrent:

No studies have reported on the concurrent validity of the MET in a stroke population.

Predictive:

One study examined predictive validity of the MET-HV with a sample of patients with acquired brain injury including stroke and reported poor to adequate correlations
between discharge MET-HV performance and community participation measured by the Mayo-Portland Adaptability Inventory (MPAI-4).

Sensitivity/Specificity:

One study reported 85% sensitivity and 95% specificity when using a cut-off score ≥ 7 errors on the MET-HV with clients with chronic acquired brain injury including stroke.

One study reported 82% sensitivity and 95.3% specificity when using a cut-off score ≥ 12 errors on the MET-SV with clients with brain injury including stroke.

Construct:

Convergent/Discriminant:

Three studies* examined convergent validity of the MET-HV and reported excellent correlations with the Modified Wisconsin Card Sorting Test (MWCST), Behavioural Assessment of Dysexecutive Syndrome battery (BADS), Dysexecutive questionnaire (DEX), IADL questionnaire and FIM Cognitive score; and an adequate correlation with the Rivermead Behavioural Memory Test (RBMT).

One study* examined convergent validity of the MET-SV and reported adequate correlations with the Weschler Adult Intelligence Scale – Revised Full Scale IQ (WAIS-R FSIQ), MWCST, BADS and Cognitive Estimates test; and poor to adequate correlations with the DEX.

One study* examined convergent validity of the BMET and reported adequate to excellent correlations with the Sickness Impact Profile and Assessment of Motor and Process Skills.

Three studies* examined convergent validity of the VMET and reported excellent correlations with the MET-HV, BADS, IADL questionnaire, Semantic Fluencies test, Tower of London test, Trail Making Test, Corsi’s supra-span test, Street’s Completion Test and the Test of Attentional Performance.

*Note: Correlations between the MET and other measures of everyday executive functioning and IADLs used in these studies also provide support for the ecological validity of the MET.

Known Groups:

Two studies reported that the MET-HV is able to differentiate between individuals with acquired brain injury (including stroke) vs. healthy adults, and between healthy older adults vs. healthy younger adults.

One study reported that the MET-SV is able to differentiate between clients with brain injury including stroke vs. healthy adults.

One study reported that the BMET is able to differentiate between clients with stroke vs. healthy adults.

Three studies reported that the VMET is able to differentiate between clients with stroke vs. healthy adults, and between healthy older adults vs. healthy younger adults.

Floor/Ceiling Effects No studies have reported on the floor/ceiling effects of the MET.
Does the tool detect change in patients?

Responsiveness of the MET has not been formally evaluated, however:

  • One study used a modified version of the MET-HV and MET-SV to measure change following intervention;
  • One study used the MET-HV and the VMET to detect change in multi-tasking skills of clients with stroke following intervention.
Acceptability The MET provides functional assessment of executive function as it enables clients to participate in real-world activities.
Feasibility Administration of the MET requires access to a shopping area and so is not always feasible in a typical clinical setting. Some tasks may need to be adapted depending on the rehabilitation setting. Administration time can be lengthy. Ecological validity is supported.
How to obtain the tool? Baycrest MET is available from the author: ddawson@research.baycrest.org

Psychometric Properties

Overview

A literature search was conducted to identify publications on the psychometric properties of the Multiple Errands Test (MET) relevant to a population of patients with stroke. Of the 10 studies reviewed, 8 included a mixed population of patients with acquired brain injury including stroke. Studies have reviewed psychometric properties of the original MET, Hospital Version (MET-HV), Simplified Version (MET-SV), Baycrest MET (BMET) and Virtual MET (VMET), as indicated in the summaries below. While research indicates that the MET demonstrates adequate validity and reliability in populations with acquired brain injury including stroke, further research regarding responsiveness of the measure is warranted.

Floor/Ceiling Effects

No studies have reported on floor/ceiling effects of the MET with a stroke population.

Reliability

Internal consistency:

Knight, Alderman & Burgess (2002) calculated internal consistency of the MET-HV in a sample of 20 patients with chronic acquired brain injury (traumatic brain injury, n=12; stroke, n=5, both TBI and stroke, n=3) and 20 healthy control subjects matched for gender, age and IQ, using Cronbach’s alpha. Internal consistency was adequate (α=0.77).

Test-retest:

No studies have reported on the test-retest reliability of the MET.

Intra-rater:

No studies have reported on the intra-rater reliability of the MET.

Inter-rater:

Knight, Alderman & Burgess (2002) calculated inter-rater reliability of the MET-HV error categories in a sample of 20 patients with chronic acquired brain injury (traumatic brain injury, n=12; stroke, n=5, both TBI and stroke, n=3) and 20 healthy control subjects matched for gender, age and IQ, using intraclass correlation coefficients. Participants were scored by 2 assessors. Inter-rater reliability was excellent (ICC ranging from 0.81-1.00). The ‘rule breaks’ error category demonstrated the strongest inter-rater reliability (ICC=1.00).

Dawson, Anderson, Burgess, Cooper, Krpan and Stuss (2009) examined inter-rater reliability of the BMET with clients with stroke (n=14) or traumatic brain injury (n=13) and healthy matched controls (n=25), using Intraclass Correlation Coefficients and 2-way random effects models. Participants were scored by two assessors. Inter-rater reliability was adequate to excellent for the five summary measures used: mean number of tasks completed accurately (ICC = 0.80), mean number of rules adhered to (ICC = 0.71), mean number of total errors (ICC = 0.82), mean number of total rules broken (ICC = 0.88) and mean number of requests for help (ICC = 0.71).

Validity

Content:

Shallice & Burgess (1991) evaluated the MET in a sample of 3 patients with traumatic brain injury (TBI) who demonstrated above-average performance on measures of general ability and normal or near-normal performance on frontal lobe tests, and 9 age- and IQ-matched controls. Participants were monitored by two observers and were scored according to number of errors (inefficiencies, rule breaks, interpretation failures, task failures and total score) and qualitative observation. The patients demonstrated qualitatively and quantitatively impaired performance, particularly relating to rule breaks and inefficiencies. The most difficult subtest was the least sensitive part of the procedure and presented difficulties for both patients and control subjects.

Criterion:

Concurrent:

No studies have reported on the concurrent validity of the MET in a stroke population.

Predictive Validity

Maier, Krauss & Katz (2011) examined predictive validity of the MET-HV in relation to community participation with a sample of 30 patients with acquired brain injury including stroke (n=19). Community participation was measured using the Mayo-Portland Adaptability Inventory (MPAI-4) Participation Index (M2PI), completed by the participant and a significant other. The MET-HV was administered 1 week prior to discharge from rehabilitation and the M2PI was administered at 3 months post-discharge. Analyses were performed using Pearson correlation analysis and partial correlation controlling for cognitive status using FIM Cognitive scores. Predictably, higher MET-HV error scores correlated with more restrictions in community participation. There were adequate correlations between participants’ and significant others’ M2PI total score and MET-HV total error score (r = 0.403, 0.510 respectively), inefficiencies (r = 0.353, 0.524 respectively) and rule breaks (r = 0.361, 0.449 respectively). The ability for the MET total error score to predict the M2PI significant other score remained significant but poor following partial correction controlling for cognitive status using FIM Cognitive scores (r = 0.212).

Sensitivity/ Specificity:

Knight, Alderman & Burgess (2002) investigated sensitivity and specificity of the MET-HV in a sample of 20 patients with chronic acquired brain injury (traumatic brain injury, n=12; stroke, n=5, both TBI and stroke, n=3) and 20 healthy control subjects matched for gender, age and IQ*. A cut-off score ≥ 7 errors (i.e. 5th percentile of total errors of control subjects) resulted in correct identification of 85% of participants with acquired brain injury (85% sensitivity, 95% specificity).

*Note: IQ was measured using the National Adult Reading Test – Revised Full Scale Intelligence Quotient (NART-R FSIQ).

Alderman et al. (2003) reported on sensitivity and specificity of the MET-SV with 46 individuals with no history of neurological disease and 50 clients with brain injury including stroke (n=9). Using a cutoff score ≥ 12 errors (i.e. 5th percentile of controls) results in 44% sensitivity (i.e. correct classification of clients with brain injury) and 95.3% specificity (i.e. correct classification of healthy individuals). The authors caution that deriving a single measure based only on number of errors fails to consider between-group qualitative differences in performance. Accordingly, error scores were recalculated to reflect “normality” of the error type, with weighting of errors according to prevalence in the healthy control group (acceptable errors seen in up to 95% of healthy controls = 1; errors demonstrated by ≥ 5% of healthy controls = 2; errors unique to the patient group = 3). Using a cutoff score ≥ 12 errors (5th percentile of controls) resulted in 82% sensitivity and 95.3% specificity. The MET-SV was more sensitive than traditional tests of executive function (Cognitive Estimates, FAS Verbal Fluency, MWCST), and MET-SV error category scores were highly predictive of rating s of executive symptoms of patients who passed traditional executive function tests but failed the MET-SV shopping task.

Construct:

Convergent/Discriminant:

Knight, Alderman & Burgess (2002)* examined convergent validity of the MET-HV by comparison with tests of IQ and cognitive functioning, traditional frontal lobe tests and ecologically sensitive executive function tests, in a sample of 20 patients with chronic acquired brain injury (traumatic brain injury, n=12; stroke, n=5, both TBI and stroke, n=3). Tests of IQ and cognitive functioning included the National Adult Reading Test – Revised Full Scale Intelligence Quotient (NART-R FSIQ), Weschler Adult Intelligence Scale – Revised Full Scale Intelligence Quotient (WAIS-R FSIQ), Adult Memory and Information Processing Battery (AMIPB), Rivermead Behavioural Memory Test (RBMT) and Visual Objects and Space Perception battery (VOSP). Frontal lobe tests included verbal fluency, the Cognitive Estimates Test (CET), Modified Card Sorting Test (MCST), Tower of London Test (TOLT) and versions of the hand manipulation and hand alternation tests. Ecologically sensitive executive function tests included the Behavioural Assessment of the Dysexecutive Syndrome battery (BADS) and the Test of Everyday Attention (TEA) Map Search and Visual Elevator tasks. The Dysexecutive (DEX) questionnaire was also used, although proxy reports were used rather than self-reports due to identified lack of insight of individuals with brain injury. There were excellent correlations between the MCST percentage perseverative errors with MET-HV rule breaks (r=0.66) and MET-HV total errors (r=0.67) following Bonferroni adjustment. There were excellent correlations between the BADS Profile score and the MET-HV task failures (r = -0.58), interpretation failures (r = 0.64) and total errors (r = -0.57). There was an excellent correlation between the DEX intentionality factor and MET-HV task failures (r = 0.70). In addition, the relationship between the MET-HV and DEX was re-evaluated to control for possible confounding effects; controlling variables age, familiarity and memory function with respect to MET-HV task failures resulted in excellent correlations with the DEX total score (r = 0.79) and DEX inhibition (r = 0.69), intentionality (r = 0.76) and executive memory (r = 0.67) factors. There was an adequate correlation between the RBMT Profile Score and the MET-HV number of task failures (r=-0.57). There were no significant correlations between the MET and other tests of IQ and cognitive functioning (MET-HV, NART-R FSIQ, WAIS-R FSIQ, AMIPB, VOSP), and other frontal lobe tests (verbal fluency, CET, TOLT, hand manipulation and hand alternation tests), other ecologically sensitive executive function tests (TEA Map Search and Visual Elevator tasks) or other DEX factors (positive affect, negative affect).

Note: Initial correlations were measured using Pearson correlation coefficient and significance levels were subsequently adjusted by Bonferroni adjustment to account for multiple comparisons; results reported indicate significant correlations following Bonferroni adjustment.

Rand, Rukan, Weiss & Katz (2009a)* examined convergent validity of the MET-HV by comparison with measures of executive function and IADLs with a sample of 9 patients with subacute or chronic stroke, using Spearman correlation coefficients. Executive function was measured using the BADS Zoo Map test and IADLs were measured using the IADL questionnaire. There were excellent negative correlations between the BADS Zoo Map and MET-HV outcome measures of total number of mistakes (r = -0.93), partial mistakes in completing tasks (r = -0.80), non-efficiency mistakes (r = -0.86) and time to complete the MET (r = -0.79). There were excellent correlations between the IADL questionnaire and the MET-HV number of mistakes of rule breaks (r = 0.80) and total number of mistakes (r = -0.76).

Maier, Krauss & Katz (2011)* examined convergent validity of the MET-HV by comparison with the FIM Cognitive score with a sample of 30 patients with acquired brain injury including stroke (n=19), using Pearson correlation analysis. There was an excellent negative correlation between MET-HV total errors score and FIM Cognitive score (r = -0.67).

Alderman, Burgess, Knight and Henman (2003)* examined convergent validity of the MET-SV by comparison with tests of IQ, executive function and everyday executive abilities with 50 clients with brain injury including stroke (n=9). Neuropsychological tests included the WAIS-R FSIQ, BADS, Cognitive Estimates Test, FAS verbal fluency test, a modified version of the Wisconsin Card Sorting Test (MWCST) and the DEX. There were adequate correlations between MET-SV task failure errors and WAIS-R FSIQ (r = -0.32), MWCST perseverative errors (r = 0.39), BADS profile score (r = -0.46) and Zoo-Map (r = -0.46) and Six Element Test (r = -0.41) subtests. There were adequate negative correlations between MET-SV social rule breaks and the Cognitive Estimates (r = -0.33), and between MET-SV task rule breaks, social rule breaks and total rule breaks and the BADS Action Program subtest (r = -0.42, -0.40, -0.43 respectively). There were poor to adequate negative correlations between the DEX and MET-SV rule breaks (r = -0.30), task failures (r = -0.25) and total errors (r = -0.37).

In a subgroup analysis of individuals with brain injury who passed traditional executive function tests but failed the MET-SV (n=17), there were adequate to excellent correlations between MET-SV inefficiencies and DEX factors of intentionality and negative affect (r = 0.59, -0.76); MET-SV interpretation failures and DEX inhibition and total (r = -0.67, -0.57); MET-SV total and actual rule breaks and DEX inhibition (r = -0.70, 0.66), intentionality (r = 0.60, 0.64) and total (r = -0.57, 0.59); MET-SV social rule breaks and DEX positive and negative affect (r = 0.79, -0.59); MET-SV task failures and DEX inhibition and positive affect (r = -0.58, -0.52), and MET-SV total errors and DEX intentionality (r = 0.67).

Dawson et al. (2009)* examined convergent validity of the BMET by comparison with other measures of IADL and everyday function with 14 clients with stroke, using Pearson correlation. Other measures included the DEX (significant other report), Stroke Impact Profile (SIP), Assessment of Motor and Process Skills (AMPS) and Mayo Portland Adaptability Inventory (MPAI) (significant other report). There were excellent correlations between the BMET number of rules broken and the SIP – Physical (r = 0.78) and Affective behavior (r = 0.64) scores and the AMPS motor score (r = -0.75). There was an adequate correlation between the BMET time to completion and SIP physical score (r = 0.54).

Rand et al. (2009a)* examined convergent validity of the VMET by comparison with the BADS Zoo Map test and IADL questionnaire with the same sample of 9 patients with subacute or chronic stroke, using Spearman correlation coefficients. There was an excellent negative correlation between the BADS Zoo Map and VMET outcome measure of non-efficiency mistakes (r = -0.87), and between the IADL and VMET total number of mistakes (r = -0.82).

Rand et al. (2009a) also examined the relationships between the scores of the VMET and those of the MET-HV using Spearman and Pearson correlation coefficients. Among patients with stroke, there were excellent correlations between MET-HV and VMET outcomes for the total number of mistakes (r = 0.70), partial mistakes in completing tasks (r = 0.88) and non-efficiency mistakes (r = 0.73). Analysis of the whole population indicated adequate to excellent correlations between MET-HV and VMET outcomes for the total number of mistakes (r = 0.77), complete mistakes of completing a task (r = 0.63), partial mistakes in completing tasks (r = 0.80), non-efficiency mistakes (r = 0.72) and use of strategies (r = 0.44), but not for rule break mistakes.

Raspelli et al. (2010) examined convergent validity of the VMET by comparison with neuropsychological tests, with 6 clients with stroke and 14 healthy subjects. VMET outcome measures included time, searched item in the correct area, sustained attention, maintained sequence and no perseveration. Neuropsychological tests included the Trail Making Test, Corsi spatial memory supra-span test, Street’s Completion Test, Semantic Fluencies and Tower of London test. There were excellent correlations between the VMET variable ‘time’ and the Semantic Fluencies test (r = -0.87) and the Tower of London test (r = -0.82); between the VMET variable ‘searched item in the correct area’ and the Trail Making Test (r = 0.96); and between the VMET variables ‘sustained attention’, ‘maintained sequence’ and ‘no perseveration’ and Corsi’s supra-span test (r = 0.84) and Street’s Completion Test (r = -0.86).

Raspelli et al. (2012) examined convergent validity of the VMET by comparison with the Test of Attentional Performance (TEA) with 9 clients with stroke. VMET outcome measures included time, errors, inefficiencies, rule breaks, strategies, interpretation failures and partial-task failures. Authors reported excellent correlations between the VMET outcomes time, inefficiencies and total errors and TEA tests (range r = -0.67 to 0.81).

Note: Other neuropsychological tests were administered but correlations are not reported (Mini Mental Status Examination (MMSE), Beck Depression Inventory (BDI), State and Trait Anxiety Index (STAI), Behavioural Inattention Test (BIT) – Star Cancellation Test, Brief Neuropsychological Examination (ENB) – Token Test, Street’s Completion Test, Stroop Colour-Word Test, Iowa Gambling Task, DEX and ADL/IADL Tests).

*Note: The correlations between the MET and other measures of everyday executive functioning and IADLs also provide support for the ecological validity of the MET (as reported by the authors of these articles).

Known Group:

Knight, Alderman & Burgess (2002) examined known-group validity of the MET-HV in a sample of 20 patients with chronic acquired brain injury (traumatic brain injury, n=12; stroke, n=5, both TBI and stroke, n=3) and 20 healthy control subjects (hospital staff members) matched for gender, age and IQ*. Clients with brain injury made significantly more rule breaks (p=0.002) and total errors (p<0.001), and achieved significantly fewer tasks (p<0.001) than control subjects. Clients with brain injury used significantly more strategies such as looking at a map (p=0.008), reading signs (p=0.006), although use of strategies had little effect on test performance. The test was able to discriminate between individuals with acquired brain injury and healthy controls.

*Note: IQ was measured using the National Adult Reading Test – Revised Full Scale Intelligence Quotient (NART-R FSIQ).

Rand et al. (2009a) examined known group validity of the MET-HV with 9 patients with subacute or chronic stroke, 20 healthy young adults and 20 healthy older adults, using Kruskal Wallis H. Patients with stroke made more mistakes than older adults on VMET outcomes of total mistakes, mistakes in completing tasks, partial mistakes in completing tasks and non-efficiency mistakes, but not rule break mistakes or use of strategies mistakes. Older adults made more mistakes than younger adults on VMET outcomes of total mistakes, partial mistakes in completing tasks and non-efficiency mistakes, but not mistakes in completing tasks, rule break mistakes or use of strategies mistakes.

Alderman et al. (2003) examined known group validity of the MET-SV with 46 individuals with no history of neurological disease (hospital staff members) and 50 clients with brain injury including stroke (n=9), using a series of t-tests. Clients with brain injury made significantly more rule breaks (t = 4.03), task failures (t = 10.10), total errors (t = 7.18), and social rule breaks (chi square 4.3) than individuals with no history of neurological disease. Results regarding errors were preserved when group comparisons were repeated using age, familiarity and cognitive ability (measured by the NART-R FSIQ) as covariates (F = 11.79, 40.82, 27.92 respectively). There was a significant difference in task failures between groups after covarying for age, IQ (measured by the WAIS-R FSIQ) and familiarity with the shopping centre (F = 11.57). Clients with brain injury made approximately three times more errors as healthy individuals. For both groups, rule breaks and task failures were the most common errors.

Dawson et al. (2009) examined known group validity of the BMET with 14 clients with stroke and 13 healthy matched controls, using a series of t-tests. Clients with stroke performed significantly worse on number of tasks completed accurately (d = 0.84, p<0.05), rule breaks (d = 0.92, p<0.05) and total failures (d = 1.05, r<0.01). The proportion of group members who completed fewer than 40% (< 5) tasks satisfactorily was also significantly different between the two groups (28% of clients with stroke vs. 0% of healthy matched controls, p<0.05).

Note: d is the effect size; effect sizes ≥ 0.7 are considered large.

Rand et al. (2009a) examined known group validity of the VMET with a sample of 9 patients with subacute or chronic stroke, 20 healthy young adults and 20 healthy older adults, using Kruskal Wallis H. Patients with stroke made more mistakes than older adults on all VMET outcomes except for rule break mistakes. Older adults made more mistakes than young adults on all VMET outcomes except for the use of strategies mistakes.

Raspelli et al. (2010) examined known group validity of the VMET with 6 clients with stroke and 14 healthy subjects. There were significant differences between groups in time taken to execute the task (higher for healthy subjects) and in the partial error ‘Maintained task objective to completion’.

Raspelli et al. (2012) examined known group validity of the VMET with 9 clients with stroke, 10 healthy young adults and 10 healthy older adults, using Kruskal-Wallis procedures. Results showed that clients with stroke scored lower in VMET time and errors than older adults, and that older adults scored lower in VMET time and errors than young adults.

Responsiveness

Two studies used the MET (MET-HV, VMET and modified version of the MET-HV & MET-SV) to measure change following intervention.

Novakovic-Agopian et al. (2011) developed a modified version of the MET-HV and MET-SV to be used in local hospital settings. They developed 3 alternate forms that were used in a pilot study examining the effect of goal-oriented attentional self-regulation training with a sample of 16 patients with chronic brain injury including stroke or cerebral hemorrhage (n=3). A pseudo-random crossover design was used. During the first 5 weeks, one group (Group A) completed goal-oriented attentional self-regulation training while the other group (Group B) only received a 2-hour educational instructional session. In the subsequent phase, conditions were switched such that participants in Group B received goals training for 5 weeks while those in Group A received educational instruction. At week 5 the group that received goal training first demonstrated a significant reduction in task failures (p<0.01), whereas the group that received the educational session demonstrated no significant improvement in MET scores. From week 5 to week 10 there were no significant changes in MET scores in either group.

Rand, Weiss and Katz (2009b) used the MET-HV and VMET to detect change in multi-tasking skills of 4 clients with subacute stroke following virtual reality intervention using the VMall virtual supermarket. Clients demonstrated improved performance on both measures following 3 weeks of multi-tasking training using the VMall virtual supermarket.

References

  • Alderman, N., Burgess, P.W., Knight, C., & Henman, C. (2003). Ecological validity of a simplified version of the multiple errands shopping test. Journal of the International Neuropsychological Society, 9, 31-44.
  • Dawson, D.R., Anderson, N.D., Burgess, P., Cooper, E., Krpan, K.M., & Stuss, D.T. (2009). Further development of the Multiple Errands Test: Standardized scoring, reliability, and ecological validity for the Baycrest version. Archives of Physical Medicine and Rehabilitation, 90, S41-51.
  • Knight, C., Alderman, N., & Burgess, P.W. (2002). Development of a simplified version of the Multiple Errands Test for use in hospital settings. Neuropsychological Rehabilitation, 12(3), 231-255.
  • Maier, A., Krauss, S., & Katz, N. (2011). Ecological validity of the Multiple Errands Test (MET) on discharge from neurorehabilitation hospital. Occupational Therapy Journal of Research: Occupation, Participation and Health, 31(1) S38-46.
  • Novakovic-Agopian, T., Chen, A.J.W., Rome, S., Abrams, G., Castelli, H., Rossi, A., McKim, R., Hills, N., & D’Esposito, M. (2011). Rehabilitation of executive functioning with training in attention regulation applied to individually defined goals: A pilot study bridging theory, assessment, and treatment. The Journal of Health Trauma Rehabilitation, 26(5), 325-338.
  • Novakovic-Agopian, T., Chen, A. J., Rome, S., Rossi, A., Abrams, G., Dʼesposito, M., Turner, G., McKim, R., Muir, J., Hills, N., Kennedy, C., Garfinkle, J., Murphy, M., Binder, D., Castelli, H. (2012). Assessment of Subcomponents of Executive Functioning in Ecologically Valid Settings: The Goal Processing Scale. The Journal of Health Trauma Rehabilitation, 2012 Oct 16. [Epub ahead of print]
  • Rand, D., Rukan, S., Weiss, P.L., & Katz, N. (2009a). Validation of the Virtual MET as an assessment tool for executive functions. Neuropsychological Rehabilitation, 19(4), 583-602.
  • Rand, D., Weiss, P., & Katz, N. (2009b). Training multitasking in a virtual supermarket: A novel intervention after stroke. American Journal of Occupational Therapy, 63, 535-542.
  • Raspelli, S., Carelli, L., Morganti, F., Poletti, B., Corra, B., Silani, V., & Riva, G. (2010). Implementation of the Multiple Errands Test in a NeuroVR-supermarket: A possible approach. Studies in Health Technology and Informatic, 154, 115-119.
  • Raspelli, S., Pallavicini, F., Carelli, L., Morganti, F., Pedroli, E., Cipresso, P., Poletti, B., Corra, B., Sangalli, D., Silani, V., & Riva, G. (2012). Validating the Neuro VR-based virtual version of the Multiple Errands Test: Preliminary results. Presence, 21(1), 31-42.
  • Shallice, T. & Burgess, P.W. (1991). Deficits in strategy application following frontal lobe damage in man. Brain, 114, 727-741.

See The Measure

How to obtain the Multiple Errands Test?

See the papers below for test instructions of the Simplified Version (MET-SV) and the Hospital Version (MET-HV):

  • Alderman, N., Burgess, P.W., Knight, C., & Henman, C. (2003). Ecological validity of a simplified version of the multiple errands shopping test.Journal of the International Neuropsychological Society, 9, 31-44.
  • Knight, C., Alderman, N., & Burgess, P.W. (2002). Development of a simplified version of the Multiple Errands Test for use in hospital settings.Neuropsychological Rehabilitation, 12(3), 231-255.

The Baycrest MET can be obtained by contacting the author: ddawson@research.baycrest.org

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